The Book Review, Sunday, April 1, 2012: Meaning, Medicine and the 'Placebo Effect'

Have you ever had such an incredible headache that aspirin couldn't touch it but then someone suggested going to the movie and even though you didn't feel like it you went and once you got into the movie you felt no pain and then when the movie was over you suddenly realized you hadn't been in pain but as soon as you realized that the pain came back?

That's not an example of the placebo effect, but it does show just how much the pain we feel can be influenced by what's going on around us.

In "Meaning, Medicine and the 'Placebo Effect,'" by Daniel Moerman, we get insight into something even more difficult to understand: the fact that illnesses can be "cured" as well as pain relieved by chemically inert medical treatments. In fact, just being seen by a kind and caring medical professional, and especially receiving a diagnosis, can "cure" a person in many cases.

Here are just a few of the factors involved:

---Culture of origin:  If you believe that being born under certain astrological signs makes you unlucky or likely to die from a certain disease, the chances that you will die from that disease are much greater than for someone who does not share that belief.

---Country of origin: If you're American, you may think that getting a shot will help you get well better than taking a pill will, and you'll probably be right.

---Disease or diagnosis: Conditions ranging from lumbar disk herniation to Meniere's disease have been "cured" equally well by real surgery and "negative operations." But if you have a headache, taking a "placebo" pill will not be as helpful as taking a real aspirin (though going to a movie may help!).

---The patient's own life experiences and cultural background: This is huge, ranging from whether you're an optimist or not (patients who rated their own health as "excellent" had better than twice as good a chance of being still alive after several years as those who rated their health as "poor").

---The patient's confidence in the doctor or surgeon's ability and success: Some patients who received nothing more than three pin-pricks in their knees instead of actual arthroscopic surgery were "cured" and remained pain free for years afterwards; the same kind of results were repeated for many kinds of surgeries and treatments.

---The kind and color of the pill or capsule and the amount prescribed: Why do you think Viagra pills are blue?  Why do you think if two sugar pills make your headache go away, then four sugar pills make it go away even faster? Aha! There's something to this...

Moerman writes in his "Acknowledgments" section, "I have had great fun with this project; I kept telling myself how easy it would be to write a 'placebo book' because it doesn't have anything in it." He isn't just discussing placebos, though. He's discussing meaning in medicine, putting together his own many years of research as a medical anthropologist with research done by other anthropologists and medical professionals over decades.

With all this in mind, what would Moerman do if he were told he needed coronary artery bypass surgery, for instance? He writes:

"As with any serious and dangerous procedure, I'd first seek a second opinion. If the second opinion were the same as the first, I would go ahead with the procedure. I would want an enthusiastic and very experienced surgeon (I know just the guy), and I would ask him to be as non-invasive as possible....I would ask that they play Louis Armstrong recordings during the operation--loudly!--and that I be able to listen to Stan Getz and Joao Gilberto in the recovery room.

"And, when I have a headache, or some aches or pains in my back or leg, I shake two ibuprofen tablets into my hand, I look at them carefully, and I say, 'Guys, you are the best, the most powerful and trouble-free drugs in the world.' Or something like that. Then, with a large glass of water ('Water is good, too,' I think carefully to myself), down the hatch.

"You know what I mean."

And there you have it. Madame L highly recommends this book. You don't have to be a doctor or an anthropologist to enjoy it. You should, however, be willing to give up some of your carefully cherished beliefs about medicine and healing, about placebos and their place in medicine and healing, and about yourself.

April Fool!

Dear Readers,

Hoaxes are part of the history of humanity, and if you want to get in on the fun this year, check out this website for some ideas. The Museum of Hoaxes will also alert you to whether someone is pulling your own leg.

Did you hear about the little girls in England who took photos of real fairies in their back yard? A hoax.

What about crop circles? An amazingly elaborate hoax carried on by a lot of people.

And some April Fool's Day pranks are right here, including the best ever prank...Just please don't play any cruel jokes on your friends.

Not Kidding,

Madame L

What Has Barack Obama Done?

Dear Madame L,

I don't know why you keep supporting Barack Obama, since he hasn't kept the promises he made during the 2008 elections.

Don't you think someone else could do a better job?

Sincerely,

Questioning Obama's Accomplishments

Dear Questioner,

Madame L thinks --- and knows you won't be at all surprised to read this --- that Barack Obama has done an incredible amount in his first three years of office, and, what's more, has done almost all of it in spite of continued Republican efforts to block his accomplishments, even in areas that they would have supported if anyone else had been president.

In spite of the Republicans' admitted primary goal of denying Pres. Obama a second term (cf. Senate Minority Leader Mitch McConnell of Kentucky), Pres. Obama has accomplished these things (and this is just a partial list):

Passed health care reform;

Passed the stimulus;

Passed Wall Street reform;

Ended the war in Iraq;

Began drawing down the war in Afghanistan;

Eliminated Osama bin Laden;

Turned around the U.S. auto industry;

Recapitalized banks;

Repealed "Don't Ask, Don't Tell";

Toppled Muammar Qadaffi;

Told Hosni Mubarak to go; and

Reversed Bush torture policies.

Please read "The Incomplete Greatness of Barack Obama" and "Obama's Top 50 Accomplishments" in The Washington Monthly for more information.

Madame L doesn't think anyone else could have done so much, and she's looking forward to seeing what Pres. Obama can accomplish in his next term.

Sincerely,

Madame L

This Bizarro Republican Act of Political Seppuku

Dear Madame L,

Did you hear that the Republicans are planning to oppose the "Violence Against Women Act" when women Democratic senators introduce it again this month? 

The Republican Party would be making a huge mistake, don't you think, especially since they supported the bill when it was first introduced in 1994? 

It seems to me like opposing this would be a bizarro act of political seppuku---especially after Rush Limbaugh's recent verbal assault on a young woman, and recent and ongoing Republican attempts not only to make even medically necessary abortions harder for women to obtain but to make contraception and even general medical care harder for women to obtain.

Sincerely, 

Do They Want to be Known as the Party That Hates Women?

Dear Reader Who Doesn't Hate Women,

Is it all right if Madame L calls you that? Madame L hopes she's right in assuming that you support this legislation.

Madame L thinks the Republican Party is going to have to do a quick turn-around on women's health and safety issues if it wants to retain the support of very many women in this country. 

Madame L has read also that Republican presidential primary front-runner Mitt Romney is going against his work as governor in Massachusetts in favor of health care for women, and that he even promised to end Medicare if he's elected president. (Madame L has read that Mr. Romney, who just turned 65, hasn't enrolled in Medicare because he won't be needing Medicare for himself --- a luxury that most people simply don't have!)

But, Madame L digresses. Here's an excerpt from the New York Times article about the proposed bill: 

"'I am furious,' said Senator Maria Cantwell, Democrat of Washington. 'We’re mad, and we’re tired of it.'

"Republicans are bracing for a battle where substantive arguments could be swamped by political optics and the intensity of the clash over women’s issues. At a closed-door Senate Republican lunch on Tuesday, Senator Lisa Murkowski of Alaska sternly warned her colleagues that the party was at risk of being successfully painted as antiwoman — with potentially grievous political consequences in the fall, several Republican senators said Wednesday." 

The article goes on to note that conservatives are feeling "trapped" by the introduction of this legislation at this point. Madame L notes that she hears their tiny violins and doesn't want to hear the chorus.

Again, quoting from the Times: "The legislation would continue existing grant programs to local law enforcement and battered women shelters, but would expand efforts to reach Indian tribes and rural areas. It would increase the availability of free legal assistance to victims of domestic violence, extend the definition of violence against women to include stalking, and provide training for civil and criminal court personnel to deal with families with a history of violence. It would also allow more battered illegal immigrants to claim temporary visas, and would include same-sex couples in programs for domestic violence."

Madame L thinks this is a law whose time has come, again and again, and anyone who opposes it, for whatever reason, really does hate women.

Sincerely,

Madame L

The Book Review, Sunday, March 25, 2012: The Book Thief

Dear Readers,

This is the best book Madame L has read in ages. Please read it.

Oh, do you want some more details?

Liesel Meminger's parents are Communists in Nazi Germany. Her little brother dies even as Liesel's mother is taking them to a foster home to be safe. Their father has already been taken away, and soon enough Liesel finds out that her mother has been taken, too.

Is that why Liesel steals books? No, it is not. The many reasons for Liesel becoming the book thief are too complex to relate here.

Maybe you would have to be Death Himself to understand why. And that's okay, because Death is the narrator of the Liesel's story. Can you imagine a more appropriate --- or more omniscient --- narrator for a story about surviving Nazi Germany?

Don't try to read this book while you need to focus on something else. It's not great beach or airplane reading. It demands that you savor every sentence, that you go back and re-read whole passages, that you promise yourself to re-read the whole book.

But read it. You'll find more satisfaction in reading this book than in any quick-read page-turner. Madame L promises you that.

Should Obama Apologize to Afghanistan?

Dear Madame L,

I'm really sorry for those poor Afghan people whose family members were killed in a crazy rampage by a single U.S. serviceman last week.

But I don't think the President of the United States should have to apologize for it. I think Pres. Obama is apologizing way too much. 

Sincerely,

It Wasn't His Fault

Dear Non-Apologist,

Madame L agrees with you that those killings, and the other horrible things that have been done, whether purposely or accidentally, by American soldiers and contractors in Iraq are not Pres. Obama's fault. 

But Madame L notes that Washington Post fact-checkers discovered that Pres. Obama is NOT going on some "apology tour," as his detractors have claimed. Instead, they found, he "repeatedly extolled America and its ideals. Like his predecessors, Obama has become practiced in conceding error without saying sorry..."

But, more importantly, here's why it's very wise of our President to apologize for in this way---"conceding error without saying 'sorry'"---for such acts as the Koran burning and the more recent massacre, from "The Politics of Sorry," by Karl E. Meyer, in "Foreign Policy":

"Few wounds fester longer than a failure to acknowledge gross abuses, even in times long past. Japan to this day remains tongue-tied regarding treatment of Korean "comfort women" during World War II and is still faulted in Asia for its tardy and awkward apologies for its wartime transgressions. Turkey steadfastly resists to even acknowledge its indiscriminate slaughter of Armenians by Ottoman troops during World War I, prompting the French National Assembly to pass a law criminalizing denial of what is widely regarded as a genocide. Turkey, for its part, accuses France of ignoring its own crimes perpetrated during an Algerian war that claimed more than a million lives (Algeria's count) or at least 300,000 lives (in France's reckoning) -- a discrepancy ironically symmetrical with contested counts of Armenian fatalities in Turkey."

What happens when national leaders do NOT apologize? Here's an example, from that same article:

"Concerning France's undeclared war in Algeria, President Nicolas Sarkozy all but shrugged prior to his sole visit to Algeria in 2007... To date, there has been no official apology for France's violent repression and use of torture in the war, so Algerians have repeatedly complained."

Partial apologies don't work. Neither does blaming someone else, or spreading or sharing the blame. And when denials are later shown to be false as the truth is revealed, the situation is even worse for the country or person responsible.

Madame L suggests that Pres. Obama's method of dealing with such unfortunate incidents, acknowledging the problem and the hurt while pledging to investigate, is the best way to handle them.

Sincerely,

Madame L

Silence Gun: No, Please, No!

Dear Madame L,

Thanks for the post about cell-phone jammers. 

But what about this new idea: a "silence gun" that doesn't disrupt any communication frequencies. It's called a "Speechjammer." It reflects the words of the person who's talking on a cell phone or chatting it up in the library right back to the person. The "echo effect" disrupts the person's ability to even think about what they're going to say next, leaving them speechless.

Sincerely,

Wanting a Quieter World

Dear Quieter,

Madame L also wants a quieter world, but she believes that fighting rudeness with incivility is not the way to achieve this dream.

Sincerely,

Madame L